"Delirium: Impact and Recognition"
by
Kathryn Agarwal

This course is intended for the interdisciplinary members of the healthcare team in the hospital setting to improve knowledge of issues surrounding delirium in the elderly hospitalized patient. This 20-question module focuses on the evidence behind the epidemiology, risk factors, impact, and recognition of delirium in the geriatric patient. Course created by Elaine Chang, and Kathryn Agarwal, MD, both of Baylor College of Medicine. Listed below is information on obtaining continuting education credits for this course. It is approved for CME, Nursing CE, Physical Therapy, Speech Therapy, and Occupational Therapy.

Photo of Robert Parker, MD, used by permission from Lisa Krantz and New York Times.

The funding for creation of this educational module is by the Texas Consortium Geriatric Education Center (TCGEC) at Baylor College of Medicine. Founded in 1985, the TCGEC is one of 48 such centers funded by the federal Health Resources and Services Administration.

The funding for the ongoing administration and continuing education credits for this educational module is supported by Funding Opportunity Number CMS- 1C1-12-0001 from Centers for Medicare and Medicaid Services, Center for Medicare and Medicaid Innovation. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.

We acknowledge the following individuals who reviewed and edited this module:

Rose Bjorklund, P.T.

Catherine Currier-Buckingham, P.T. MBA

Elinor Hart, P.T.

Judith J. Joseph, OTR, MA

Lindsay Norene, M.A. CCC-SLP

Tom MacAdam, P.T.

Anita Major, M.D.

Jennifer Mebane, M.A. CCC-SLP

Lindsay Norene, M.D. CCC-SLP

Shannon Pearce, DNP, RN, A/GNP-BC

Judy Ragsdale, P.T.

James Rudolph, M.D.

Sarah Sheedy, MS CCC-SLP

George Taffet, M.D.

Terry Throckmorton, PhD, RN

Pam Willson, PhD, RN, FNP-BC

Delirium SpacedEd Education - CME /CE Credit Information

Activity OverviewStudies have shown that in patients over age 70, there is a 14-24% prevalence of delirium on admission and a 6-54% incidence of delirium in the hospital. Futhermore, despite an incidence of delirium of up 50%, and only 2.5% of cases reported in one study were classified within a diagnosis-related group (DRG) for delirium or a synonym. This low recognition factor vs. actual inicidence is one the most significant problems in geriatrics: clinicians do not recognize delirium as a severe problem, do not know how to diagnose it , and are unaware that it may be prevented with improved methods of care. By using an educational intervention teaching the most commonly used diagnostic algorithm for deliruim and delivering this intervention to all members of the health care team, we hope to signicicantly increase the rate of recognition of delirium.

Please click on this link to learn more about the observational research study that is occuring for participants taking this course.

Target Audience The target audience for this activity is physicians and nurses and interdisciplinary teams in a hospital setting.

Educational ObjectivesAt the conclusion of this activity, the participants should be able to:

Recognize risk factors for development of delirium

State possible adverse outcomes related to delirium

Use the Confusion Assessment Method* tool to screen for delirium

List strategies to prevent delirium

Implement appropriate management techniques in the hospital

Educational Methods

The Interactive Spaced Education [ISE] Delirium Module 1: Recognition, Risk factors and Impact of Delirium in Hospitalized Elders program will consist of 20 multiple- choice questions on delirium in the geriatric patient in the hospital setting. The module will begin with two questions every other day in a single email from the website, www.qstream.com. This website will facilitate the delivery of questions and answers to the participant.

- If a question is answered incorrectly, the participant will receive the same question 8 days later.

- If a question is answered correctly, the participant will receive the same question 20 days later.

- If the participant answers the question correctly two times in a row, the question is then retired from the program and is no longer repeated.

- The participant will complete the program when all 20 questions are retired (each question is answered correctly twice in a row)

Given these parameters, it is estimated that the participant will complete the program in less than three months.

Participants may receive credit or contact hours ONLY by completing 80% of the questions in a module AND completing the end of module survey in LESS THAN FOUR MONTHS FROM TIME OF ENROLLMENT.

Accreditation and Credit Designation StatementsThe Methodist Hospital System® is accredited by the Accreditation Council for Continuing Medical Education(ACCME) to sponsor continuing medical education for physicians.

The Methodist Hospital System® designates this educational activity for a maximum of 2.0 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

The estimated time to complete this education activity: 2.0 hours

Release date: January 2012 Expiration date: December 31, 2013

Nursing CE Credit

The Methodist Hospital is an approved provider of continuing nursing education by the Texas Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. This module has been approved for 1.9 Contact Hours.

Physical Therapy CE Credit

This course has been submitted for approval from the Texas Board of Physical Therapy Examiners to meet continuing education requirements for P.T.s and P.T.A.s.

Contact Hours: 2.0

CCUs: 2.0

TPTA Approval ID#52327A

Speech Therapy CE Credit

Texas Speech-Language-Hearing Association (TSHA)

“Delirium: Impact and Recognition”

Sponsored by : The Texas Consortium of Geriatric Education Centers, Baylor College of Medicine, Houston, TX

This continuing education activity was approved by the Texas Speech-Language-Hearing Association (TSHA) and can be applied toward the renewal o the Texas license in Speech-Language Pathology and/or Audiology as well as the Certificate of Clinical Competence from the America Speech-Language Hearing Association (ASH)

Contact Hours: 2.0

CCUs: 2.0

Course # 20120227441

Occupational Therapy CE Credit

This course is approved for Occupational Therapy Continuing Education Credits in Texas.

Texas Consortium of Geriatric Centers/Baylor College of Medicine

is hereby granted status as a TOTA Approved Provider.

Texas Consortium of Geriatric Education Centers / Baylor College of Medicine HAS BEEN APPROVED

FOR 2 hours of Type 2 Education.

How to Receive Credit

The following Spaced Education module consist of 20 multiple choice questions. Questions will be sent to you in small amounts from the website www.qstream.com. Once you answer a question correctly two times in a row, it will be completed. Participants may receive credit or contact hours ONLY by completing all 20 questions in a module AND completing the end of module survey in LESS THAN FOUR MONTHS FROM TIME OF ENROLLMENT. A certificate of participation will be available online following successful completion of the module and the post module survey.

Disclosure Policy and Procedure

The Methodist Hospital System (TMHS) Office of Continuing Medical Education (OCME) makes every effort to develop CME activities that are scientifically based, accurate, current, and objectively presented. In accordance with the Accreditation Council for Continuing Medical Education Standards for Commercial Support, TMHS has implemented a mechanism requiring everyone in a position to control content of an educational activity (e.g., directors, planning committee members, contributors, peer reviewers, CME staff) to disclose any relevant financial relationships with commercial interests (drug/device companies) and manage/resolve any conflicts of interest prior to the activity. Individuals must disclose to participants the existence or non-existence of financial relationships: 1) at the time of the activity or 12 months prior; and 2) of their spouses/partners.

The Methodist Hospital System does not view the existence of interests or relationships with commercial entities as implying bias or decreasing the value of a presentation. It is up to the participants to determine whether the interests or relationships influence the presenter with regard to exposition or conclusions.

In addition, contributors have been requested to use generic names for products (drugs/devices), and to include various products within and across classes. If at any time during this activity you feel that there has been commercial or promotional bias, please inform us by using the commercial bias comments box in the evaluation form. Please answer the question about balance in the CME activity evaluation candidly.

Some drugs/devices identified during this activity may have United States Food and Drug Administration (FDA) clearance for specific purposes only or for use in restricted research settings. The FDA has stated that it is the responsibility of the individual physician to determine the FDA status of each drug or device that he/she wishes to use in clinical practice and to use the products in compliance with applicable law.

The Methodist Hospital System requires that all faculty disclose any unlabeled use or investigational use (not yet approved for any purpose) of pharmaceutical and medical device products, and provide adequate scientific and clinical justification for such use. Physicians are urged to fully review all the available data on products or procedures before using them to treat patients.

Faculty Disclosure(s)

The following planning committee members disclosed having no financial relationships. There will not be mention of any off-label or unapproved uses.

Course Details

This course is intended for the interdisciplinary members of the healthcare team in the hospital setting to improve knowledge of issues surrounding delirium in the elderly hospitalized patient. This 20-question module focuses on the evidence behind the epidemiology, risk factors, impact, and recognition of delirium in the geriatric patient.

Reviews

This course does a superb job of introducing delirium, reminding us that it is a very common adverse effect of hsopitalization and that lack of attention is the key to differentiating it from dementia. Well done.

This is a well thought out course that encourages the learner to participate due to the e-mail reminders. The ease of logging on and participation is very helpful. The review of material after the questions is quite understandable, concise and educational, helping to incoporate increased knowledge of delirium.

The situation stated before the question does not give enough information. The patient canhave some encephalopathy secondary to liver or renal or other metabolic dysfunction. They can be on steroids causing psychosis. The information and questions are too general and vague.

The question regarding Mr. Brown and his myocardial infarction has a miss spelling in the scenario. At the end of the statements, he is diagnosed with myocardial infection which can affect the way someone answers the question. Thanks

About
Kathryn Agarwal

Kathryn Agarwal, MD, is an Assistant Professor of Medicine at Baylor College of Medicine in Houston, TX. She leads hospital programs for elders, like the Acute Care for the Elderly Unit at Park Plaza Hospital, and leads the geriatrics consultation service at Ben Taub General Hospital. She is interested in developing interdisciplinary education progams to improve the care of hospitalized elders.